Impaired Bone Microarchitecture Improves After One Year On Gluten‐Free Diet: A Prospective Longitudinal HRpQCT Study in Women With Celiac Disease
01 Jan 2017-Journal of Bone and Mineral Research (John Wiley & Sons, Ltd)-Vol. 32, Iss: 1, pp 135-142
TL;DR: This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation, however, there were still significant differences with a control group of women of similar age and BMI.
Abstract: We have recently identified a significant deterioration of bone microarchitecture in premenopausal women with newly diagnosed celiac disease (CD) using high-resolution peripheral quantitative computed tomography (HRpQCT). The aim of this work was to assess changes in bone microarchitecture after 1 year on a gluten-free diet (GFD) in a cohort of premenopausal women. We prospectively enrolled 31 consecutive females at diagnosis of CD; 26 of them were reassessed 1 year after GFD. They all underwent HRpQCT scans of distal radius and tibia, areal BMD by DXA, and biochemical tests (bone-specific parameters and CD serology) at both time points. Secondary, we compared 1-year results with those of a control group of healthy premenopausal women of similar age and BMI in order to assess whether the microarchitectural parameters of treated CD patients had reached the values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia improved significantly (trabecular density, trabecular/bone volume fraction [BV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]). Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [UD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at CD diagnosis improved significantly by specific treatment (GFD) and calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. In the prospective follow-up of this group of patients we expect to be able to assess whether bone microarchitecture attains levels expected for their age. © 2016 American Society for Bone and Mineral Research.
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TL;DR: Topics that play a role in the occurrence and prevention of fractures are discussed, and an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention are given.
Abstract: Osteoporosis is a silent disease with increasing prevalence due to the global ageing population. Decreased bone strength and bone quality is the hallmark of osteoporosis which leads to an increased risk of fragility fractures in elderly. It has been estimated that approximately ~50% of women will suffer during their lifetime from an osteoporotic fracture. This must be considered as a major health concern, as it has previously been established that fragility fracture has been associated with decreased quality of life due to increased disability, more frequent hospital admission and most importantly, osteoporotic fractures have been related to an augmented mortality risk. Anti-osteoporotic drugs are available for improving bone quality. Although there is access to these therapeutic options, there remain multiple unmet needs in the field of osteoporosis and fracture care, for example, the primary prevention of osteoporosis in young individuals (to reach a high peak bone mass), the optimization of the use of imaging techniques [dual-energy X-ray absorptiometry (DXA), vertebral fracture assessment (VFA) and new techniques measuring bone quality], the use of nonmedical treatment options and surgical techniques of fracture healing. In this review, we will discuss topics that play a role in the occurrence and prevention of fractures, and we give an overview of and insight into the critical issues and challenges around osteoporosis and fracture prevention.
85 citations
TL;DR: Presentations are variable, from asymptomatic patients to severe malnutrition, and initial detection usually relies on celiac-specific serology, and confirmation often requires intestinal biopsy.
84 citations
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TL;DR: The phosphated plantain flour represents a raw material with great potential for the development of gluten-free food (bread and cookie) with functional properties, i.e. health benefits.
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TL;DR: In this article, the nutritional imbalances which may be found in adults with Celiac disease following a gluten-free diet were described, and the most notable deficiencies in micronutrients are usually those of iron, calcium and magnesium and vitamin D, E and some of group B.
Abstract: Celiac disease (CD) is a chronic autoimmune disorder of the small intestine, whose only effective treatment is a gluten-free diet (GFD). It is characterized by the atrophy of the intestinal villi that leads to altered nutrient absorption. This study describes the nutritional imbalances which may be found in adults with CD following a GFD. During the first year of treatment, deficiencies will overcome as the intestinal mucosa recovers. Thus, biochemical data will show this progression, together with the decrease in symptoms. In contrast, in the long term, when a strict GFD is followed and mucosal recovery is achieved, analyzing nutrient intake makes more sense. Macronutrient consumption is characterized by its low complex carbohydrate and fiber intakes, and high fat (especially SFA) and sugar intakes. This profile has been related to the consumption of GFP and their nutritional composition, in addition to unbalanced dietary habits. The most notable deficiencies in micronutrients are usually those of iron, calcium and magnesium and vitamin D, E and some of group B. It is necessary to follow up patients with CD and to promote nutritional education among them, since it could help not only to achieve a gluten free but also a balanced diet.
32 citations
References
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Beth Israel Deaconess Medical Center1, Harvard University2, University of Pavia3, University of Maryland, Baltimore4, Columbia University5, Royal Hallamshire Hospital6, University of Tampere7, Imperial College London8, University of Oslo9, Mayo Clinic10, University of Naples Federico II11, University of Salerno12
TL;DR: A multidisciplinary task force of 16 physicians from seven countries used the electronic database PubMed to review the literature for CD-related terms and suggested a definition for each term, followed by feedback through a web survey on definitions and discussions during a meeting in Oslo.
Abstract: Objective The literature suggests a lack of consensus on the use of terms related to coeliac disease (CD) and gluten. Design A multidisciplinary task force of 16 physicians from seven countries used the electronic database PubMed to review the literature for CD-related terms up to January 2011. Teams of physicians then suggested a definition for each term, followed by feedback of these definitions through a web survey on definitions, discussions during a meeting in Oslo and phone conferences. In addition to ‘CD’, the following descriptors of CD were evaluated (in alphabetical order): asymptomatic, atypical, classical, latent, non-classical, overt, paediatric classical, potential, refractory, silent, subclinical, symptomatic, typical, CD serology, CD autoimmunity, genetically at risk of CD, dermatitis herpetiformis, gluten, gluten ataxia, gluten intolerance, gluten sensitivity and gliadin-specific antibodies. Results CD was defined as ‘a chronic small intestinal immune-mediated enteropathy precipitated by exposure to dietary gluten in genetically predisposed individuals’. Classical CD was defined as ‘CD presenting with signs and symptoms of malabsorption. Diarrhoea, steatorrhoea, weight loss or growth failure is required.’ ‘Gluten-related disorders’ is the suggested umbrella term for all diseases triggered by gluten and the term gluten intolerance should not to be used. Other definitions are presented in the paper. Conclusion This paper presents the Oslo definitions for CD-related terms.
1,324 citations
TL;DR: HR-pQCT appears promising to assess bone density and microarchitecture at peripheral sites in terms of reproducibility and ability to detect age- and disease-related changes.
Abstract: Context: Assessment of trabecular microarchitecture may enhance the prediction of fracture risk and improve monitoring of treatment response. A new high-resolution peripheral quantitative computed tomography (HR-pQCT) system permits in vivo assessment of trabecular architecture and volumetric bone mineral density (BMD) at the distal radius and tibia with a voxel size of 82 μm3. Objective and Patients: We determined the short-term reproducibility of this device by measuring 15 healthy volunteers three times each. We compared HR-pQCT measurements in 108 healthy premenopausal, 113 postmenopausal osteopenic, and 35 postmenopausal osteoporotic women. Furthermore, we compared values in postmenopausal osteopenic women with (n = 35) and without previous fracture history (n = 78). Design and Setting: We conducted a cross-sectional study in a private clinical research center. Intervention and Main Outcome Measure: We took HR-pQCT measurements of the radius and tibia. Femoral neck and spine BMD were measured in post...
1,124 citations
"Impaired Bone Microarchitecture Imp..." refers background or methods or result in this paper
...HRpQCT allows 3D assessment of bone microarchitectural characteristics measuring cortical and trabecular compartments separately, and giving a more profound insight into bone pathophysiology.((14)) The trabecular compartment, as we had hypothesized, because of its higher remodeling rate, increased the most....
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...Its high resolution (82 mm) permits the direct and reliable assessment of these parameters, which are relevant to bone strength.((14,15)) Using this technique,wehadpreviously identifieda significantdeterioration of bone microarchitecture in premenopausal women with newly diagnosed CD....
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...High-resolution peripheral quantitative computed tomography (HRpQCT), which is a noninvasive method for volumetric three-dimensional (3D) characterization of peripheral skeletal sites, allows quantification of bone microarchitectural parameters.((14,15)) Its high resolution (82 mm) permits the direct and reliable assessment of these parameters, which are relevant to bone strength....
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...These values are similar to what other authors have published for this method.((14))...
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Karolinska Institutet1, Örebro University2, Universidad del Salvador3, University of Nottingham4, University of Salerno5, Guy's and St Thomas' NHS Foundation Trust6, Columbia University7, British Dietetic Association8, Queen Mary University of London9, Harvard University10, St Mary's Hospital11, University of Oslo12, Coeliac UK13, Cardiff and Vale University Health Board14, University of Newcastle15, University of Sheffield16
TL;DR: A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries reviewed the literature on diagnosis and management of adult coeliac disease and the recommendations are presented.
Abstract: A multidisciplinary panel of 18 physicians and 3 nonphysicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.
842 citations
"Impaired Bone Microarchitecture Imp..." refers background in this paper
...This enteropathy, triggered by dietary gluten, is characterized by the presence of autoantibodies and results in a variety of intestinal and extraintestinal, clinical and subclinical manifestations.((2)) One of the most common and best described extraintestinal manifestations is the presence of osteopenia and osteoporosis and the consequent higher fracture risk....
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TL;DR: The methodology of the 2013 ISCD Body Composition PDC is described, the recommendations pertain to clinically relevant issues regarding DXA indications of use, acquisition, analysis, quality control, interpretation, and reporting are addressed and the results are summarized.
407 citations
TL;DR: This poster discusses the epidemiology and management of celiac disease, a chronic, immunologically determined form of enteropathy affecting the small intestine in genetically predisposed children and adults.
Abstract: CONTENTS1 Definitions2 Key points3 Epidemiology4 Diagnosis of celiac disease5 Management of celiac diseaseDEFINITIONSCeliac disease (CD) is a chronic, immunologically determined form of enteropathy affecting the small intestine in genetically predisposed children and adults. It is precipitated by th
274 citations
"Impaired Bone Microarchitecture Imp..." refers methods in this paper
...Diagnosis of CD was based on wellestablished criteria (positive CD serology tests and abnormal duodenal histology).((17)) More detailed baseline data on these patients was described in a recently published work....
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